The Black Women's Health Imperative, the new name of the National Black Women's Health Project, has co-sponsored three research studies: Reach 2010: At the Heart of New Orleans, Black Women's Wellness Study and The Impact of Psychosocial Factors on Health: A Study of African American Women. The primary research objective for all Imperative-sponsored studies is to contribute to the body of knowledge that increases the understanding of the health of Black women. For more information about these studies, please contact the Black Women's Health Imperative.
REACH 2010: At the Heart of New Orleans
The REACH 2010: At the Heart of New Orleans project is a church-based, demonstration project funded by the Centers for Disease Control and Prevention (CDC) that was initiated in 2000. The overarching goal of this five-year project is to develop, implement and evaluate an innovative, church-based community program to eliminate the disparities in cardiovascular diseases that face Black women. Through this project, the Black Women's Health Imperative seeks to enhance knowledge, change attitudes and increase the willingness to change lifestyles among church-based African American women with cardiovascular disease risk factors.
The Black Women's Health Imperative (the Imperative) serves as the Central Coordinating Organization (COO) with three other coalition partners. The Reach 2010 coalition is comprised of institutions that bring valuable expertise and knowledge in program development, public health education and research on cardiovascular health. This faith-based project has partnered with 40 churches including the Congress of National Black Churches Orleans affiliate, the Black Women's Health Project of Louisiana, the City of New Orleans Health Department, the Louisiana State Office of Public Health Cardiovascular Health Section, Healthy Heart Primary Prevention Project and other community, faith-based partners. The target population for the Reach 2010: At the Heart of New Orleans project is African American women 18-years-old and older who live in Orleans Parish.
Orleans Parish is comprised of 484,674 residents of which 63.7 percent are African American and 33.6 percent are living below poverty level. In 1996, Louisiana had the ninth highest mortality rate due to cardiovascular diseases, accounting for 39 percent of all deaths. The median income in Orleans Parish is $25,200. Of the residents who are over 25 years of age, 12 percent are in college and 17 percent are high school graduates. The U.S. median income is currently $37,005.
Through the REACH 2010 Demonstration Program, CDC directly funds 31 community coalitions, which include traditional public health partners such as county, city and state health departments, community-based organizations, universities and community health clinics; and less traditional public health partners such as boards of education and faith-based organizations. Two additional coalitions are funded by the California Endowment, a private foundation in California. Of the 33 coalitions, 23 or 70 percent are working on the health priority issues of cardiovascular disease and/or diabetes. These issues were selected by the coalitions, often with community input. They identified cardiovascular disease and diabetes as the highest health priorities for eliminating health disparities within their communities.
For more information about REACH 2010, please access the following link: www.BlackWomensHealth.ORG/REACH2010
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Black Women's Wellness Study
For more information about this study, please contact the Black Women's Health Imperative.
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The Impact of Psychosocial Factors on Health: A Study of African American Women
This June 2001 study by Bettina M. Beech, Dr.P.H., M.P.H. and Isabel C. Scarinci, Ph.D., M.P.H. represents a partnership between the Black Women's Health Imperative and the University of Memphis Center for Community Health (UMCCH). UMCCH is a joint venture of the Health Research Group of the University of Memphis and the Department of Preventive Medicine at the University of Tennessee, Memphis. The founding premise indicated that African American women needed to address the relationship between negative socioeconomic factors and stress and related health problems.
A combined interest and concern with the psychosocial well-being of African American women led to the study. Although large-scale national studies such as the Behavioral Risk Factor Surveillance Survey (BRFSS), National Health and Nutrition Examination Survey (NHANES) and the Commonwealth Women's Health Study included African Americans and the results were compared to whites. To the researcher's knowledge, the only national study that had examined psychosocial well-being and its correlates exclusively among African Americans was the National Survey of Black Americans (NSBA) conducted in 1979-1980,1987-1988,1988-1989 and 1992.
The NSBA has focused primarily on major social, economic, and psychological issues among African Americans, and it has provided unique information on psychological well-being and coping strategies among African Americans. However, the NSBA study did not specifically focus on African American women, and did not address some relevant psychosocial issues experienced by this population (e.g. health care provider-patient communication, domestic violence, child abuse).
Compared to other racial/ethnic groups, African American women are disproportionately affected by cardiovascular disease, some forms of cancer, hypertension and diabetes. Lifestyle risk factors such as obesity, lack of physical activity, tobacco use and diets high in sodium are well known contributors to these chronic diseases. However, sociocultural factors (e.g. discrimination, domestic violence, stress and depression) are also hypothesized to contribute to the aforementioned diseases and behaviors are less often examined in large-scale studies with African American women.
Health surveys included in large-scale studies yield some information about the health status of ethnic minority populations, however, these groups have historically often been inadequately or inaccurately represented in health research. Often study samples have either excluded ethnic minority women or have included them in such small numbers that prohibit significant and appropriate statistical analysis such as the heterogeneity of behavioral risk factors associated with chronic disease among African American women. For example, in the 1999 Behavioral Risk Factor Surveillance Survey (BRFSS), only 5.9 percent of the total sample was represented by African American women.
Specific psychosocial health issues and the factors that influence their respective outcomes may be quite different for African American women compared with other racial/ethnic groups. Even more significant however, may be the heterogeneity of these issues within sub-groups of African American women. The purpose of this study was to provide an in-depth examination and analysis of the psychosocial issues within and among African American women that would lead to the development of interventions that can better address and effectively target the predisposing, reinforcing and enabling factors that affect the psychological well-being of African American women.
The findings in the report reflected a sample of African American women who were predominantly college-educated and report yearly family incomes above $20,000. The sample size was quite large (N=1821), and it reflected a response reate of 37 percent. Although the response rate was fairly consistent with what is expected in large-scale studies in which a warm contact was not made, the results should be interpreted with caution.
Summary of Findings:
- Almost 100 percent of respondents indicated having a source of health care.
- Household income and educational attainment played a role in health care provider-patient communication. The higher the household income, the greater the health care provider-patient communication. In addition, African American women with high school education or higher endorsed greater health care provider-patient communication than African American women with less than high school education.
- Approximately 30 percent of respondents reported having had difficulty in communicating with their health care providers. Approximately 50 percent of respondents with less than high school education indicated having difficulty talking with their health care providers.
- Overall, a small percentage (16.5 percent) of respondents indicated that they have avoided the discussion of problems and needs with their health care provider due to the discomfort of either party. However, this percentage was much higher (30.5 percent) among African American women under 31 years of age.
- Approximately 25 percent of African American women indicated that their health care provider had ever made comments that were offensive or inappropriate.
- Over 60 percent of African American women had ever changed health care providers due to dissatisfaction. The higher the income and educational attainment, the more likely African American women were of changing providers due to dissatisfaction.
- Approximately 60 percent of respondents screened positive for depressive symptomatology. Household income, educational attainment, and age appeared to play an important role in depressive symptomatology in this population.
- At least 60 percent of African American women rated the following events as stressful in the past year: future security, time pressures, household responsibilities, work, health concerns, and financial pressures.
- A gradient relationship between household income, age and discrimination found the lower the household income and the younger the respondents, the higher the likelihood of an endorsement of experiencing discrimination.
- Being treated with less respect than other people (30.8 percent), people acting as if they are better than you (28.7 percent), and being treated as not smart (25.2 percent) were the leading discriminatory items endorsed by the groups of African American women.
- This group of African American women tended to endorse high levels of social support.
- The percentage of women who indicated they had experienced domestic violence was very low. However, approximately 25 percent did not answer the questions associated with domestic violence.
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- A large percentage (43 percent) of respondents reported being verbally or emotionally abused as a child. Approximately 20 percent of respondents indicated being physically abused as a child, and 22 percent reported being sexually abused as a child. Of the women who had experienced abuse, approximately 60 percent indicated they had discussed abuse with someone.